Toffol G J, Lansky L L, Hughes J R, Blend M J, Pavel D G, Kecskes S A, Ortega R E, Tan W S
J Child Neurol. 1987 Apr;2(2):134-8. doi: 10.1177/088307388700200209.
A 3-year-old child with phenotypic trisomy 18 syndrome survived 26 days after a cardiopulmonary arrest, secondary to an acute viral illness. The child was deeply comatose. No barbiturates, other sedatives, or aminoglycoside antibiotics had been recently administered. The child was normothermic with adequate cardiovascular function. Brain stem function was absent, as assessed by testing of brain stem reflexes. Serial cerebral radionuclide angiograms (CRAG) documented intact cerebral blood flow while electrocerebral silence (ECS) was present on two consecutive EEG recordings within 24 hours. Preservation of intracranial circulation was confirmed by rapid rotational computed tomographic (CT) scans. Cranial CT scans also revealed communicating hydrocephalus, and bilateral basal ganglia hemorrhages. This unusual case illustrates discordance between apparent irreversible loss of cortical function as indicated by electrocerebral silence with preserved cerebral blood flow. The implications of these apparent paradoxical events will be discussed in the context of defining brain death in children.
一名患有18三体综合征表型的3岁儿童在心肺骤停后存活了26天，心肺骤停继发于急性病毒性疾病。该儿童处于深度昏迷状态。近期未使用过巴比妥类药物、其他镇静剂或氨基糖苷类抗生素。该儿童体温正常，心血管功能良好。通过脑干反射测试评估，脑干功能丧失。连续的脑放射性核素血管造影（CRAG）记录显示，在24小时内连续两次脑电图记录出现脑电静息（ECS）时，脑血流保持完整。快速旋转计算机断层扫描（CT）证实颅内循环得以保留。头颅CT扫描还显示交通性脑积水和双侧基底节出血。这个不寻常的病例说明了脑电静息所表明的明显不可逆皮质功能丧失与保留的脑血流之间的不一致。这些明显矛盾事件的意义将在儿童脑死亡定义的背景下进行讨论。
